The ear—the organ responsible for hearing and balance—may be affected by various auricular maladies. One example is infection of the middle ear area, also known as otitis media, which may be manifested as local auricular pain, often associated with systemic symptoms such as fever, nausea, vomiting, and diarrhea. Some patients may also describe unilateral hearing impairment. Diagnosis is based on otoscopy—a visual inspection of the ear and ear-drum, also known as tympanic membrane—which may show a bulging and erythematous tympanic membrane with indistinct landmarks and displacement of the light reflex. Spontaneous perforation of the tympanic membrane may cause sero-sanguineous or purulent discharge from the ear, known as otorrhea. Although acute otitis media may occur at any age, it is most common between ages 3 months and 3 years. At this age range, the eustachian tube—a narrow channel connecting the middle ear with the naso-pharynx—is wider, shorter, and more horizontal than in adults. Etiology of acute otitis media may be bacterial or viral—the latter is often complicated by secondary bacterial infection.
Acute otitis media is one of the most common reasons practitioners prescribe antibiotics for children. In addition to their antibacterial activity, antibiotics may relieve symptoms quickly and may reduce the chance of residual hearing loss and labyrinthine or intracranial sequelae. However, frequent non-compliance and/or non-adherence to treatment recommendations or regimen by patients or caregivers often results in failure of antimicrobial therapy of otitis media.